Abstract
Introduction
Patients, who are terminally ill, are often affected by negative symptoms, such as anxiety and depression. These symptoms hinder their psychologic well-being and can reduce their ability to tolerate physical illness as well as their quality of life or that of their caregivers. 1
To deal with these issues, complementary techniques, such as animal-assisted interventions (AAIs), 2 are used, in combination with conventional approaches, to improve the quality of life of patients, who are terminally ill.
Interventions with animals in palliative care have shown to provide benefits to patients. 3 However, according to MacDonald and Barrett, 3 there should be more evidence concerning the procedures and methodologies applied and evaluation of results.
In this study, the authors apply AAI using a dog as animal model to analyze the effect of gender and pet ownership on the levels of anxiety and depression in terminally ill patients.
Materials and Methods
The study was conducted on a sample set of 44 patients, who were hospitalized in three palliative care Operative Units (O.U.) of the Aulss 3 Serenissima National Healthcare Centre (Venice, Italy). All the subjects enrolled were considered terminal patients, according to the definition of Lamont, 4 although not necessarily affected by cancer but also by other deadly pathologies. The research protocol was approved by the Ethics Committee of the Aulss 3 Serenissima.
Age (≥18 years) and suitability to be exposed to the test, as determined by a multidisciplinary team (physician, psychologist, and nurses), were used as inclusion criteria. Allergies to animals and animal phobias, on the contrary, were used as exclusion criteria.
All participants gave their informed written consent before testing. They also completed the questionnaires (demographic data as well as the Italian version of the Hospital Anxiety and Depression Scale (HADS), 5 before and after being exposed to a 20-min AAI session. All patients were hospitalized in single rooms and the test consisted in interacting with a dog by touching and stroking it freely. All patients were calm before being exposed to the animal.
Only one session of AAI was administered considering the patients' clinical conditions (i.e., most of them were very close to death).
Results
Thirty-two patients out of 44 were men (72.7%) with an average age of 70 years (mean value = 69.1, SD = 12.99). Most of the patients (n = 38, 86.4%) were pet owners, or had been in the past.
A set of generalized linear models was used to assess the patients' variations of anxiety and depression before and after the treatment, taking into account the interactions with the variables gender and pet ownership.
Patients did not express significant variations in anxiety before and after the treatment, not even when anxiety was correlated to gender. The same results emerged when the linear model was applied to depression: no significant variation was found before and after the treatment also when depression was put in interaction with gender.
The results changed when the variable pet ownership was correlated to anxiety or depression. The interaction between pet ownership and depression remained nonsignificant, whereas it became significant when pet ownership was correlated to anxiety (p = 0.047). Interestingly, it is found that anxiety, after the interaction with a dog, slightly decreased in patients who were or had been pet owners, whereas it increased considerably in nonpet owners (refer to Table 1 for further details).
Results of the Generalized Linear Models for Anxiety and Depression and Their Interactions with Gender and Pet Ownership
Bold indicates significant value.
Discussion
An interesting and statistically significant difference was found in the levels of anxiety expressed by patients after the AAI session, which appeared to be correlated to pet ownership. Anxiety, in fact, decreased in patients, who owned a pet or had been pet owners before, whereas it increased in nonpet owners after having interacted with the animal. The authors observed that in their clinical experience with AAI, the presence of the animal favored the memory of the animal/s they had owned in patients who were pet owners or had previously been. This often led patients to talk about their imminent death. This is an issue that should be further investigated because it could be that hooking the painful memory of the death of a pet favors access to the thought of one's own, imminent death, which explains why pet owners were less anxious and probably calmer in facing their own death than nonpet owners.
Although the results are promising, there are many limitations of this study that should be highlighted. The first is related to the unbalanced sample size of the two experimental groups (owners vs. nonowners) that made it hard to compare results between the two subsamples. Another strong limitation was related to the serious health conditions of the patients under study. Finally, the study can be poorly compared with the literature as previous studies reported of the effect of AAI techniques using more than one session. 6,7
The aim in future research is to repeat the study using a larger sample size and a more balanced number of owners versus nonowners (collecting data even from a control group) and extending the analysis to patients affected by less severe conditions.
Notwithstanding, this study suggests, with a cautious optimism, that the intervention and interaction with a dog in palliative care can be of relief in terminal patients. However, the difference between pet owners and nonpet owners must be taken into account, a difference that could make AAI not suitable for all patients.
Footnotes
Acknowledgments
A heartfelt thank you goes to the handlers of the dogs, S. Cossaro and to the psychologists R. Manente, A. Marcassa, S. Siggia, and I. Simionato.
Author Disclosure Statement
No competing financial interests exist.
Funding Information
No funding was received for this article.